According to the first results of a new study, an American stroke treatment awareness program called “Stroke Ready“, did not improve the overall thrombolysis treatment rate.
However, the study found that the hospital component of the program, which aims to optimize stroke care in the emergency department (ED), increased thrombolysis rates.
The analysis also showed that thrombolysis treatment rates increased in Flint compared to other Michigan cities, and that ethnic disparities were virtually eliminated during the study.
The results were presented at the 2023 International Stroke Conference (ISC).
Post-stroke disability is common, and although treatments for acute stroke can significantly reduce it, relatively few patients benefit from these treatments, the researchers point out.
Le projet Stroke Ready
Stroke Ready is a multi-faceted project, launched to address this underutilization of acute stroke treatments in the predominantly black community of Flint, Michigan.
The goal of the program is to teach residents to recognize the signs of stroke and to go to the hospital for medical treatment as soon as they appear.
« We are very proud to announce that we have reached nearly 6,000 people with face-to-face stroke education workshops said study author Dr. Lesli E. Skolarus, vice president of faculty development, professor of neurology at the Feinberg School of Medicine, and director of the Community Center for Community Academic Consultations Center for Community Health, Northwestern University, during his presentation at the conference. She added that this represents regarding 10% of Flint’s adult population.
Twenty-eight trained peer educators conducted more than 230 face-to-face workshops. Relevant information was also disseminated through print media as well as social and digital media.
Flint’s stroke population included 3,327 residents, with an average age of 67.8 years, of whom 55.6% were female and 52.5% were black. Dr. Skolarus noted that there were no demographic differences between the pre-intervention population and the post-intervention population.
The study used a prospective quasi-experimental interrupted time series evaluation of the Stroke Ready program. The primary endpoint was the use of an intravenous tissue plasminogen activator (tPA).
The analysis showed that the probability of undergoing thrombolysis increased from 4% in 2010 to 12% in 2020 without taking Stroke Ready into account, and to 14% when the program was taken into account.
« This absolute difference of 2 percentage points was not statistically significant.e,” Dr. Skolarus said. The adjusted odds ratio (ORc) was 1.12 (confidence interval [0,74–1,70] ; p=0,58).
The study had a number of predefined secondary endpoints. One evaluated the ED and community components of the intervention separately as part of Stroke Ready.
For the SU part, the probability of receiving a tPA increased to regarding 15% from the 10% predicted by the model. “This absolute increase of 5 percentage points was statistically significant,” noted Dr. Skolarus (OR: 1.6; 95% CI: 1.03–2.6; P = 0,03).
However, this was not the case for the community component of the intervention.
Dr. Skolarus noted that community interventions are “ difficult to assess in a real context.
« Truly unbelievable »
When researchers looked at Flint’s performance compared to four other Michigan communities with similar demographics, they found that Flint ” was initially a very underperforming city but that in 2020 it ended up being the city, among those studied, having used thrombolysis the most said Dr. Skolarus.
« We think Flint should be happy regarding it because it’s really amazing “, she added. ” In a time of public health crisis, Flint has become a city with one of the highest rates of thrombolysis treatment. »
In terms of ethnic differences, the study found that black stroke patients were associated with greater increases in thrombolysis rates than stroke stroke white patients. In 2010, Flint was characterized by a great disparity in the use of thrombolytic treatments according to ethnic origins, but this disparity “ decreased or even disappeared in 2020 said Dr. Skolarus.
The study lacked sufficient statistical power, which is one of its limitations. In addition, the COVID-19 pandemic “ shortened our community intervention and follow-up period said Dr. Skolarus.
She added that the study was designed to determine the impact of the whole intervention, not that of separate components.
Next steps might include conducting cluster-randomised trials of ED intervention as part of Stroke Ready, Dr. Skolarus said. ” I also think we should think regarding how to adapt the Stroke Ready community response to make it more effective. »
Superb work
In a comment for Medscape Medical NewsDr. Larry B. Goldstein, professor and chief of the department of neurology at the University of Kentucky (University of Kentucky), said that the study “was very well done” and that it had “ learned a lot ».
Organizers ” have done a superb job working with the community”, so it is “a little confusing” that the program has not had an overall effect he estimated.
Raising awareness in the community is really, really important “, and the authors of the study” have shown that this is possible and can be done in a way that really involves the community “, did he declare.
Dr. Goldstein noted that overall thrombolysis rates increased, but this was not significant following accounting for secular trends.
« Then, when they analyzed the origin of the change, it unfortunately might not be associated with the community component but with the hospital component.. »
The study therefore showed that it is in the organization of hospitals that ” lies a large part of the benefits ” did he declare.
« In the future, it may be worth focusing on effective hypertension prevention strategies and further reducing ethnic disparities rather than focusing solely on acute stroke treatment rates. added Dr. Goldstein.
Dr. Skolarus and Dr. Goldstein declared no relevant conflicts of interest.
International Stroke Conference 2023. Latest Abstract #3. Presented February 9, 2023.
This article originally appeared on medscape.com.
